A federal lawsuit in Missouri claims a pregnant pre-trial detainee at the Cole County jail was denied basic access to healthcare that could have saved the life of her unborn child.

Sentoria McMillon sued Sheriff Greg White of Cole County, Missouri, and his jail staff. She also sued the for-profit medical contractor Advanced Correctional Healthcare (ACH), the ACH doctor, and the licensed practical nurse working at the jail.

The lawsuit alleges deliberate indifference to serious medical needs, wrongful death, and medical malpractice. ACH denies all of the allegations made in McMillon’s complaint.

Just weeks before McMillon’s due date, she suffered abdominal pain while incarcerated at the Cole County jail but was denied access to a doctor for over a week. She was eventually released on her own recognizance the night before she was scheduled to see a physician.

McMillon was taken to the emergency room, where doctors induced labor and found her unborn child had died days earlier. The dead body decayed inside her.

Had the defendants followed appropriate protocol or policy, and demonstrated simple humanity toward a pregnant inmate in distress by allowing her to see a physician, the lawsuit argues, “Doctors could have properly monitored [her] pregnancy and, if necessary, induced labor in order to provide life-saving care for [her] unborn child.”

This is not the first time ACH has faced serious allegations of medical negligence. The company has been named in numerous similar lawsuits alleging inmates were injured or died due to lack of appropriate medical care in county jails across the midwest.

Previously, inmates suffering from severe alcohol withdrawal and perforated ulcers had their needs ignored for days, while other severe medical conditions were rarely examined or treated seriously by a doctor or registered nurse.

A 2015 investigation by Shadowproof uncovered multiple cases, where ACH hired unskilled medical staff and doctors with questionable backgrounds, and minimized access to services in order to deliver inmate healthcare to county jails at the lowest possible cost.

ACH and other for-profit jail medical providers market their services based on the promise that they can deliver care at a far lower cost than the local government. Cole County’s contract with the company was renewed for another year in January, at the annual rate of $169,6791.21.

ACH covers expenses for specific medical services, sometimes up to a cap, after which the county is responsible for paying. The company does not cover “elective care” services, defined as “care which, if not provided, would not cause the inmate’s health to deteriorate or cause harm to the inmate’s well being.” The county is responsible for covering expenses related to off-site, specialists, or emergency care, as well as treatments for certain illnesses they deem to be “rare,” such as HIV. (Note: Licensed physicians employed by ACH make determinations about what conditions they will treat.)

Under this arrangement, a company like ACH can achieve its promise of controlling costs for the county by denying care to an inmate in dire need until the very last minute, at which point they are “released on their own recognizance.”

Such releases transfer the financial responsibility for their care from the county back to the individual, who then has to pay for whatever life-saving medical treatment they may need.

While ACH is not itself paying for such services, and can argue that such decisions technically have nothing to do with their bottom line, the truth is if the agreement doesn’t save the county money, it’s unlikely to be renewed.

When asked to respond to this criticism, ACH legal counsel for the Sentoria McMillon case, Tad Eckenrode, said it was “completely false to suggest that ACH denies care to patients in an effort to reduce expenses” and noted “ACH understands that a healthier inmate, more likely than not, will require fewer medical services over time, so it makes no sense to deny them care either in the facility or off-site (where needed).”

“As a general rule treatment decisions are based upon the inmate’s medical condition. While decisions are not based upon cost, providing appropriate care is generally the most fiscally responsible course for the County and the company,” Eckenrode continued, adding “It is our goal to provide quality evidence-based medical care to our patients, and make recommendations for off-site care whenever we feel that a patient’s medical condition requires it.”

Sentoria McMillon missed her court date on October 6, 2015, just weeks before she was due to give birth. According to her complaint, McMillon was absent that day because she was suffering from dehydration and went to visit her prenatal care physician at the University of Missouri Women’s and Children’s Hospital (UM-WCH).

She appeared in court the following day and was arrested. She was taken to the Cole County Jail, where ACH is under contract to provide medical services to inmates.

During intake, McMillon let her jailers know she was pregnant and close to her due date. She was then placed in a holding cell, where she felt abdominal pains and “significant pelvic pressure.” She vomited, complained of pain, and cried. Her jailers took her blood pressure and called the doctor, Dr. Catherine Van Voorn.

Like several other ACH doctors, Dr. Van Voorn has been punished for violating state laws and medical ethics in the course of her practice.

In 2013, Van Voorn was “publicly reprimanded” by the Missouri State Board of Registration for the Healing Arts and ordered to complete continuing medical education courses on drug prescription after investigators found she had violated state controlled substance laws “[dispensing] drugs without labels, [faxing] prescriptions to pharmacies without her signature, [failing] to keep records of prescriptions and [allowing] a nurse to prescribe drugs.”

Van Voorn was also named in several other lawsuits for failing to adequately address an inmate’s dire medical needs.

In Clay County, Missouri, Van Voorn was sued alongside two ACH LPN’s when 61 year old Brian Sorensen, who had a duodenal ulcer and a history of health issues, died after his complaints of severe stomach pain were met with Prilosec. Local papers reported, “By the time emergency responders arrived, Sorensen was bleeding from the mouth and had no pulse.”

“Applicants who may have experienced past hardships are not necessarily unqualified or lacking proper expertise,” Eckenrode said, explaining “each applicant is evaluated on a case-by-case basis.” He argued licensing boards “may discipline licensees for a variety of regulatory violations, some of which have little to do with the quality of care they provide generally.”

“Every action taken by a licensing board is considered as part of the total picture,” Eckenrode said. “ACH does not hire people we believe to be dangerous, unfit for the job, unqualified, or lacking in proper expertise.” [Note: Eckenrode underlined the word “is.”]

“We have an extremely qualified interview team that screens applicants and are proud to employ more than 700 people in 17 states.”

Dr. Van Voorn spoke with McMillon’s jailers on the phone for roughly two and a half minutes regarding the inmate’s condition, according to the complaint. During that conversation, the jailers only told the doctor McMillon was in pain. Jailers did not mention she had just seen her prenatal physician the day before her incarceration due to complications with her pregnancy.

The jailers did not even tell the doctor McMillon was pregnant, and the doctor never asked. In fact, the complaint alleges Van Voorn barely inquired about her patient at all, whose file and face she’d never seen. Van Voorn ordered McMillon be given over-the-counter pain medication and a follow-up appointment with the nurse the next morning. McMillon’s pain persisted, and she cried through the night.

“Instead of allowing [McMillon] to see an OB/GYN or other qualified doctor, or transferring [her] to a facility where her pregnancy could be monitored or labor induced,” the lawsuit states defendants allegedly did nothing and left McMillon in a holding cell overnight.

The next day a nurse examined McMillon for the first time. The nurse took her vitals and checked her abdomen. McMillon told her she had not felt her child move since the day before. She told the nurse she was scared and asked to see a doctor, but the lawsuit says the nurse “elected to provide no further care for [McMillon] or her unborn child.”

McMillon was moved to general population the following day. She told the nurse again that she was concerned she had not felt her child move for days. This time, the nurse made a doctor’s appointment for one week later. McMillon was left to call for help for several days. She was ignored, even though she felt increased pressure around her pelvis. She was not permitted to see a doctor before her scheduled appointment.

Late in the night, hours before her appointment, McMillon was released on her own recognizance. She saw her doctor and was sent to the emergency room, where doctors induced labor and she discovered her child was dead inside her.

Doctors noted at the time of delivery the stillborn child did not have the umbilical cord wrapped around the neck, and “the baby’s skin was sloughing off and discolored.”

According to the lawsuit, “The doctors at UM-WCH informed [McMillon] that the condition of the baby’s skin indicated that the baby had been deceased for roughly one week.” This coincides with the time she began to feel abdominal pain.

When asked if ACH had policies in place for providing care to pregnant inmates, Eckenrode reiterated that medical decisions are made on a “case-by-case basis, in accordance with the standard of care applicable to the specific health professional involved with the patient at any given point in time.”

The ACH legal counsel contended the company “does not have policies and procedures regarding pregnant inmates,” and instead relies on whatever policies and procedures are in place at the facilities in which they work.

Regardless, many decisions are left to the on-site medical staff at ACH jails: licensed practical nurses, who receive significantly less training than registered nurses, as well as significantly smaller salaries.

ACH also uses on-call doctors, known as “circuit riders,” instead of on-site physicians. These doctors provide medical care to multiple jails at a time. Because the jails are often far from where the doctors live and work, they administer medical care primarily over the telephone, rarely seeing their patients face-to-face.

The conditions imposed by private jail medical contractors, like ACH, have especially devastating consequences when considering jail populations suffer from chronic and terminal illness and need medical care at higher rates than the general population. Because of the high bar required to prove deliberate medical indifference in court and potentially hold companies like ACH accountable for such actions—not to mention indemnification clauses in their contracts that limit their legal liability, this is sadly a rather safe gamble to take.